Health Insurnace Q&A
Let's Understand the basics of Health Insurance ..
1.What is Health Insurance?
Health
Insurance is a type of insurance that covers your hospitalization expenses in
the following situations:
a. In case of a sudden illness
b. In case of an accident
c. In case of any surgery, which is required in respect of any disease which
has arisen during the policy period.
2. What are the benefits of buying a Health Insurance policy?
The basic
benefits of buying a Health Insurance policy are:
a. Reimbursement for Hospitalization due to illness / disease / surgery.
b. Reimbursement for Domiciliary Hospitalization expenses in lieu of
Hospitalization.
c. Pre-hospitalization expenses
d. post-hospitalization expenses
e. Ambulance charges
The major
types of health insurance plans available in the market are -
i) Individual Health Plan
ii) Family Floater Plan
iii) Critical Illness Plan
iv) Senior Citizen Health Plan
Well, it
depends. If you plan to stay with the company forever, it may be ok. However,
when you leave the company, your cover expires and you will have to buy a new
policy. This may have implication. For example, any existing disease may not be
covered if you go for a new policy. Considering this, you may consider buying
an additional policy which will increase your coverage amount as well as come
handy if you ever decide to leave the company.
Yes, if both
husband and wife are covered from their respective employer, they can claim
from insurance provided to them by either of the companies, but not both the
companies.
The
hospitalization charges generally cover:
Pre-hospitalization expenses - Expenses incurred for the treatment of a
disease, illness or injury during a specific period immediately before
hospitalization.
Hospitalization charges - Expenses incurred while being hospitalized and in the
course of treatment.
Post-hospitalization expenses- Routine expenses incurred for the treatment of
disease, illness or injury for a specific period after discharge from hospital.
Domiciliary
(Home) Hospitalization means medical treatment for a period exceeding three
days for such illness/disease/injury which in the normal course would require
care and treatment at a Hospital/Nursing Home but actually taken at home under
any of the following circumstances:
i) The condition of the patient is such that he/she cannot be removed to the
Hospital/Nursing Home, or
ii) The patient cannot be removed to Hospital/Nursing Home for lack of accommodation
therein.
Cashless
facility is the benefit of health insurance in which you will be able to avail
the hospital services without making any advance payments. Hospital should be
one out of the list of empanelled hospitals with the respective health
insurance company.
You can
avail the benefit of cashless facility through a health card provided to you by
the TPA (Third Party Administrator) of your health insurance company.
You can
contact your TPA for assistance at any time by calling on the helpline numbers
provided to you on your health card.
No,
generally your health insurance policy does not extend the coverage to
international trips and is limited to geographical area of India, unless you
have specifically bought an international health cover policy.
For this you
need to buy a Foreign Travel Insurance Plan.
While taking
a health insurance policy, one should check the following:
List of hospitals that are tied up with the insurance company for cashless
treatment
Waiting period for pre-existing diseases
Others exclusions
Yes, you can
take multiple health insurance policies from the same company or different
companies. In that case, you can make a claim either under any one policy or
split the claim between the policies in proportion of the sum assured availed.
The premiums
charged by the health insurance company is usually the same for specific age
group. The premium usually remains constant as long as you are in the same age
bracket. But once you shift from one age bracket to another, the premium will
increase.
Yes. You can
transfer your health policy from one insurance company to another and from one
plan to another, without losing the renewal benefits for pre-existing illness.
However, this benefit will be limited to the Sum Assured (including bonus)
under previous policy.
This policy
pays an amount equal to the sum insured upon first diagnosis of a critical
illness covered under the policy. It pays the whole sum assured at the point of
diagnosis, irrespective of actual cost incurred on treatment.
Generally,
the following critical illnesses are covered: - cancer, multiple sclerosis,
coma, heart attack, bypass surgery, stroke, paralysis, kidney failure, major
organ transplant, etc. However, the same may differ from insurer to insurer.
A basic
health insurance policy generally pays only for hospitalization bills. However,
the amount of health cover may not be enough for treatment if you are diagnosed
of a critical illness. It may also lead to loss of income, change in lifestyle
and permanent disability. To help you combat these, the critical illness
insurance plan pays you lumpsum money to meet your large medical cost as well
as meet your day-to-day expenses.
In a
critical illness policy, you are covered for certain mentioned critical
illnesses only. If you have normal health insurance, you will get cover for
normal disease as well as critical illness.
There is no
hospitalization expenses or cashless benefit under Critical Illness policy. The
insured is paid an amount equal to the sum insured at the time of diagnosis of
a critical illness.
Yes,
depending on your age, plan, sum assured and other factors, the insurer company
may require you to undergo a medical check.
No, once a
claim for a particular Critical Illness has been admitted and paid, the coverage
under the Policy will automatically terminate for that insured person.
The Critical
Illness Cover generally do not insure you against following:
i) Critical illness diagnosed within first 90 days from the inception of
policy
ii) Death within 30 days of diagnosis of critical illness or surgery
iii) Illness due to smoking, tobacco, alcohol or drug intake
iv) Illness occurring due to internal or external congenital disorder
v) Critical conditions or consequences due to pregnancy or childbirth,
including caesarean
vi) HIV/AIDS infection
vii) War, terrorism, civil war, navy or military operations
viii) Any dental care or cosmetic surgery
ix) Infertility treatment
x) Hormone replacement treatment
xi) Treatment to assist reproduction
However, the above conditions may vary from insurer to insurer.
A Family
Floater Health Plan covers all the family members under one single plan. The
total sum insured is fixed and gets exausted as and when any member avails
medical services and makes a claim.
The members
coverable under a family floater can be the policyholder and his/her parents,
spouse and children. Some plans also give option to cover parent-in-laws as
well.
Premium
spent for Health Insurance Premium can be claimed for deductions under Sec 80D
with some limitations according to age.
|
Insured |
Deduction Amount |
|
|
|
Age below
60 Yrs |
Age Above
60 Yrs |
|
Self,
Spouse & Children |
25000 |
50000 |
|
Parents |
25000 |
50000 |
|
Maximum
Deduction |
50000 |
100000 |
No, all
health insurance policies do not cover dental insurance as standard coverage.
If your plan has an inbuilt feature then you can get the coverage. Some
policies offer the same as add on features.
A “Top-up”
health policy is an additional coverage for a person/family already having an
existing health insurance. It is for reimbursement of expenditure which arises
out of beyond a threshold limit of the existing cover. Reimbursement can be one
time hospitalisation or recurring during a policy term.
Regular
top-up health insurance plan only covers claims when a single claim surpasses
the threshold limit, the super top-up plan is similar to top-up plans that
enhance your health insurance sum insured. However, the difference is that
super top-up plans work on the total medical expenses incurred during the
policy year and not on a per claim basis.
Hospital
Cash Benefit is a facility that provides a fixed sum for each day of
hospitalisation of more than 24-hours. It is a fixed daily allowance that is
paid to the policyholder to meet miscellaneous expenses during the period of
hospitalisation.
The Air
Ambulance facility combines air transport with basic emergency medical services
that can transport sick or injured patients to and from healthcare facilities.
No-claim
bonus (NCB) is a discount in premium offered by health insurance companies if a
Policy holder has not made a single claim during the term of the health
insurance policy.
Auto
Restoration benefits in health insurance let the insurer restore your sum
insured to the original amount when it is exhausted by claim.
Recharge
benefit available under health insurance policy restores the sum insured when
it gets reduced due to a claim.
Most of the
health insurance policy does not cover Maternity related expenses except some
Individual/Floater Policy where it is clearly mentioned and some group
insurance policy. There are certain conditions for maternity related cover that
may vary as per policies.
Organ donor
expense benefit covers the medical and surgical expenses of the organ donor
when harvesting a major organ transplant for the insured.
The
pre-policy medical screening refers to the medical examination that is
requested by the health insurance company before the health coverage is
provided to the person.
Sum insured
in health insurance is the maximum value for a particular year that the
insurance company can pay you in the event of a hospitalisation.
Network
Hospital means Hospitals or health care providers enlisted by an insurer, TPA
or jointly by an Insurer and TPA to provide medical services to an insured by a
cashless facility.
Room Rent
means the amount charged by the hospital for the occupancy of a bed on a per
day basis.
Shared
accommodation means a hospital room with two or more patient beds.
Day-care
facility refers to the medical procedures that require hospitalisation of less
than 24-hours.
Midterm
inclusion allows adding a newly married spouse and New Born Baby by paying an
additional premium under your existing policy.
Health
insurance co-pay refers to an arrangement in which the policyholder will need
to pay a portion of the medical expenses on their own and the insurance company
will pay the remaining amount.
Capping in
health insurance refers to the limit, which is usually a percentage, up to
which the insurance company settles claims for various hospital expenses.
An initial
Waiting Period in health insurance, refers to the amount of time you'll have to
wait from the date of issue to actively start using your health insurance
policy and benefiting from it.
Specified
diseases are a list of diseases which are covered under health insurance policy
but policy holders can file a claim after a certain waiting period.
A medical
illness or injury that you have before you start a new health insurance plan
may be considered a pre-existing disease or condition.
Portability
means, the right given to Individual health insurance policyholders (Including
all members under family cover) to shift his / her policy to another health
insurance company along with transfer of credit gained for pre-existing
conditions and time bound exclusions.
Those
policyholders, who want to port-out his / her policy shall be allowed to apply
to the insurance company to migrate the policy along with all members of the
family, if any at least 30 days before the premium renewal date of his / her
existing policy. An insurer may consider even in a less than 30days period.
Pre-hospitalization expenses are medical costs incurred by the insured before getting admitted in a
hospital. Post-hospitalization expenses are medical costs incurred after
discharge from the hospital.
A health
insurance deductible is the proportion of the medical/hospitalization expenses
that you have to pay out of your pocket before you can make an insurance claim.
IRDAI has
excluded the expenses of certain items that you may incur during
hospitalisation. These expenses are called non-medical expenses and it is not
mandatory for insurance companies to compensate the same during claim
settlement.
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